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Reactive Attachment Disorder: Frequently Asked Questions (FAQs)

Over the time that we have had this site up, we’ve received several questions from a variety of people interested or in some way affected by reactive attachment disorder. Answering these questions to the best of our abilities and knowledge, we have come to know some very fine people, and have had questions of our own answered.

As many of these have been the same questions, we’ve decided to endeavor to answer them below. We are not mental health professionals, but parents who have learned a great deal more about attachment disorder than we knew only a short time ago.

We still want your letters, and we’ll continue to answer them, but for more immediate answers to common questions, you might want to browse through the FAQs below:

It is a mental disorder that sometimes occurs during the first few years of life when an infant doesn’t bond (attach) properly to its primary caregiver. This basic loss results in ongoing feelings of rage, deep shame, a lack of trust and a fear of attaching to anyone, an inability to understand cause and effect, and a compulsive need to control everyone and everything.

That’s a hard question to answer because there is no one answer. During the first few years of life, if the infant perceives that its needs are not being met by its primary caregiver, an attachment issue may develop. This is sometimes due to neglect and abuse, but it can also be a result of a hectic family environment. Children who were taken from their mother at birth due to a serious medical problem with either the mother or the infant are susceptible to attachment difficulties, as well. You’ll find more detailed information elsewhere on this site.

It sounds like my child has RAD. Why hasn’t his therapist diagnosed it?

As the diagnosis of reactive attachment disorder is relatively new, many mental health professionals are unfamiliar with it. Although our nephew had been in therapy for years, he was only diagnosed with RAD a few months ago, after he had reached the age of twelve, and my wife and I suggested it to his psychologist. Additionally, these children often suffer from secondary disorders, such as ADHD, depression, and oppositional disorder.

I’ve read the list of signs and symptoms. Can’t these things be attributed to normal childhood behaviors?

As we read through the characteristics of children with reactive attachment disorder, many of us find ourselves realizing that we’ve done some of those things when we were kids, and it is easy to consider that perhaps these are just normal childhood behaviors, or something that the child might grow out of. There are significant differences, however. For one, the RAD kid exhibits more than half (often most or all) of these characteristics. Another is a matter of extreme. You may have lied to your parents when you were a child, but you probably didn’t lie about everything, even in the face of the obvious truth. You might have done things that you knew would get you in trouble, but you most likely understood the relationship between cause and effect. At certain points in your life, you may have hurt someone’s feelings, but you recognized that they had feelings, and you were able to feel remorse. When the RAD child is aware of your feelings, it is only so that he can hurt them. Another important difference between the child with attachment disorder and a healthy child is that the RAD child has a compulsive need to control everyone in his life. The misbehaviors of a child with attachment disorder are more extreme, more pervasive, and done for different reasons than those of a healthy child.

Yes and no. They need love, but that’s not all they need. I raised a healthy child by doing only those things that seemed right, but normal parental intuition doesn’t work with RAD children, who are extremely manipulative. The RAD child will do his best to take your love and use it against you, hurting himself in the process. Without appropriate structure, love is interpreted by the child with an attachment disorder as weakness.

The compulsive need of the RAD child to control everyone and everything in his environment is an effort to feel safe. To this end, he will be very manipulative. His misbehavior is intended to prove that no one is strong enough to control him, yet when he is allowed to succeed, it reinforces his fear that no one is strong enough to keep him safe. If we are strict with our nephew, it is to prove to him that we are strong enough to keep him safe.

A child who has no empathy or appreciation of cause and effect requires structure. This not only keeps him (and everyone else) safe, but it helps him to learn that actions have consequences.

There is no medication to treat reactive attachment disorder itself, but children with RAD might take medication to help control secondary disorders, such as depression or ADHD. Our nephew is currently taking Luvox to help him control his depression, and he has taken medicine for OCD in the past.

Why is it that kids with RAD are so seldom able to go out with friends?

Children with reactive attachment disorder tend not to have close friends, but they may have other children with whom they would like to spend time. As with the healthy child, that would depend upon his behavior, who it is that he is going out with, and where they intend to go. With some exceptions, we require at least a week of good behavior before we allow our nephew to go out somewhere with anyone, something that he is seldom willing to do. This and the fact that many of his friends are disordered combine to make his excursions outside of the house few and far between.

As a parent of a child with RAD, why don’t you let your child spend the night at someone else’s house once in awhile? Wouldn’t that give you a break?

Staying with someone who does not know how to parent a child with reactive attachment disorder tends to undo much of what we have been working toward. Detached children don’t feel safe when they are given too much freedom, yet at the same time the experience serves to renew resentment for the more structured environment they will return to at home.

We do need a break sometimes, but we’ve learned to leave him only with parents who understand and are willing to parent him the RAD way. We use available respite homes, as well as leaving him for shorter periods of time with parents whom we have trained. In conjunction with other parents of RAD children, we are currently in the process of setting up a respite facility in our own small town.

I know someone who is parenting a child with RAD, but the child seems like a nice kid to me. Why is that?

We thought that for the first couple of weeks that our nephew was with us, too. We call this his public face. While some children with RAD are out of control in all areas of their lives, the worst behaviors are often limited to the home. While our nephew still felt like a visitor in our home, he was pleasant and fun to be with, but once he began to look at us as his parents, he began to challenge our authority. He continues to be manipulative outside of the home but since he’s so good at it, a lot of people don’t notice. After a few months in public school though, he was challenging those (particularly female) teachers who chose to exert appropriate authority over him.

He can, but chooses not to. Intent on proving that we could do well without her, my nephew behaved very well for almost two weeks while my wife was away on a business trip. Still, it is not as easy for him to behave as it would be for a healthy child. Although he is almost thirteen years of age, his emotional development is stuck at a much younger age.

Explanations don’t work with RAD children because they aren’t reasonable. Their misbehavior isn’t a product of misunderstanding, but a deliberate challenge to your authority as a parent. RAD children don’t understand the relationship between cause and effect. The healthy child expects to be punished for misbehavior, but the RAD child is apt to view the punishment as proof that you hate him and don’t want him to have any fun. This is a basic emotion, having nothing to do with intelligence.

My child is being treated for attachment disorder, yet he seems to be getting worse. Am I doing something wrong?

I don’t know, but not necessarily. As a child begins to heal from attachment disorder, he begins to (let himself) experience emotions that are uncomfortable. This added stress and anxiety often causes the child to push back against the healing process, which might appear as if he were getting worse when, in fact, he may have begun to heal.

Attachment therapy doesn’t end when the session is over. The bulk of the work is done at home, for which the therapy sessions are intended to facilitate. Be certain that you are taking an active part in your child’s therapy. Read some of the many available books on the subject, and be sure to communicate with your child’s therapist, to make sure that you are doing the right things at home. Also, it is important to remember that the child who doesn’t want to heal probably won’t. You can encourage, you can facilitate, and you can provide the right environment, but you cannot force him to heal, unfortunately.

How long does it take for a child to heal from reactive attachment disorder?

I don’t know. It depends on the child, primarily; but also on the therapy that he is receiving during regular sessions and at home. Some of the professionals estimate that it will take about one month for every year of age that the child has reached before beginning appropriate attachment therapy.

While none of us truly escapes the experiences of our childhood, the child with reactive attachment disorder can fully recover and go on to live a normal life.

The likelihood of a positive outcome is excellent when the child begins appropriate attachment therapy before he has reached the age of twelve. After that, there are fewer positive outcomes, but as long as the child breathes there is room for optimism.

As they grow older, they intensify their efforts to control their lives. They become more likely to resort to violence and more capable of exerting it. Those who do not receive appropriate treatment early enough may end up in residential treatment centers as their parents find themselves losing their ability to manage them as they grow in size and strength, while escalating in violence and manipulation.

Although they may adapt in many ways, RAD children do not grow out of their disorder. If not treated, they grow to become sad, angry, dysfunctional adults. While the more intelligent among them might have successful careers, they have poor relationships with others, and do not enjoy their successes.

The child without empathy has reactive attachment disorder. The adult who has not learned empathy is known as a sociopath. In extreme cases, they can be very dangerous indeed.

Edgar Allan Poe probably had reactive attachment disorder. So did Saddam Hussein, John Wayne Gacy, and Jeff Dahmer. Helen Keller was healed from it, even before it became a recognized disorder.

On the other hand, some of them do reasonably well, even without therapy. What can I say? People are individuals.